RT Journal Article
SR Electronic
T1 Patient centredness and the outcome of primary care consultations with patients with depression in areas of high and low socioeconomic deprivation
JF British Journal of General Practice
JO Br J Gen Pract
FD British Journal of General Practice
SP e576
OP e581
DO 10.3399/bjgp12X653633
VO 62
IS 601
A1 Bhautesh Jani
A1 Annemieke P Bikker
A1 Maria Higgins
A1 Bridie Fitzpatrick
A1 Paul Little
A1 Graham CM Watt
A1 Stewart W Mercer
YR 2012
UL http://bjgp.org/content/62/601/e576.abstract
AB Background Most patients with depression are managed in general practice. In deprived areas, depression is more common and poorer outcomes have been reported.Aim To compare general practice consultations and early outcomes for patients with depression living in areas of high or low socioeconomic deprivation.Design and setting Secondary data analysis of a prospective observational study involving 25 GPs and 356 consultations in deprived areas, and 20 GPs and 303 consultations in more affluent areas, with follow-up at 1 month.Method Validated measures were used to (a) objectively assess the patient centredness of consultations, and (b) record patient perceptions of GP empathy.Results PHQ-9 scores >10 (suggestive of caseness for moderate to severe depression) were significantly more common in deprived than in affluent areas (30.1% versus 18.5%, P<0.001). Patients with depression in deprived areas had more multimorbidity (65.4% versus 48.2%, P<0.05). Perceived GP empathy and observer-rated patient-centred communication were significantly lower in consultations in deprived areas. Outcomes at 1 month were significantly worse (persistent caseness 71.4% deprived, 43.2% affluent, P = 0.01). After multilevel multiregression modelling, observer-rated patient centredness in the consultation was predictive of improvement in PHQ-9 score in both affluent and deprived areas.Conclusion In deprived areas, patients with depression are more common and early outcomes are poorer compared with affluent areas. Patient-centred consulting appears to improve early outcome but may be difficult to achieve in deprived areas because of the inverse care law and the burden of multimorbidity.